Provider Demographics
NPI:1386781235
Name:CORNERSTONE CHIROPRACTIC & REHABILITATION, PA
Entity type:Organization
Organization Name:CORNERSTONE CHIROPRACTIC & REHABILITATION, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEWELLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-828-8777
Mailing Address - Street 1:50 COVE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2514
Mailing Address - Country:US
Mailing Address - Phone:207-828-8777
Mailing Address - Fax:207-828-8777
Practice Address - Street 1:49 DARTMOUTH ST
Practice Address - Street 2:SUITE A
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-1700
Practice Address - Country:US
Practice Address - Phone:207-828-8777
Practice Address - Fax:207-828-8778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR 1311111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME022072OtherBCBS
ME351404OtherHPHC
ME1092630OtherAETNA
ME8546678OtherCIGNA
ME8546678OtherCIGNA
ME=========OtherMEDNETUHC
ME8546678OtherCIGNA